Use of coercion in psychiatric care as narrated by patients,nurses and physicians

The patterns of use of outpatient services during a 1-year follow-up in seven psychiatric services in four Nordic countries were explored as a part of a Nordic comparative study on sectorized psychiatry. One-year treated incidence cohorts were used. Three main patterns of outpatient care emerged at the service system level. First, in two of the services the outpatient care was dominated by emergency contacts. In four of the services the outpatient care was dominated by scheduled contacts, and most of the patients had no emergency outpatient contacts at all. In one of the services a remarkably large number of (38%) the patients had no outpatient contact at all. In addition to the characteristics of the psychiatric services, the following variables predicted the use of emergency outpatient services: self-referral, no inpatient care and no planned outpatient contacts during the follow-up, diagnosis of adjustment disorder or functional psychosis, and being on sick leave. The following variables predicted several scheduled outpatient contacts during the follow-up: no inpatient care and two or more emergency outpatient contacts during the follow-up, female gender, age less than 65 years, no previous inpatient care, and diagnosis of non-organic psychosis, neurosis, or personality disorder.